Out-of-Network Providers

Physicians, other licensed health professionals, facilities, and ancillary providers contract directly with Buckeye for payment of covered services. If you are an out-of-network provider seeking payment for claims foremergency, post-stabilization, and any other services authorized by Buckeye, please review these guidelines below. For detailed information, please refer to the Provider Manual. Or, call Buckeye’s Provider Services Department at 1-866-296-8731.

Provider Manual (PDF)

It is important that providers ensure Buckeye has accurate billing information on file. Please provide accurate information as follows:

  • Provider name (as noted on his/her current W-9 form)
  • Physical location address
  • Billing name and address (if different)
  • Tax Identification Number

Claims eligible for payment must meet the following requirements:

  • The member is effective on the date of service;
  • The service provided is a covered benefit under the member’s contract on the
  • date of service; and
  • Referral and prior authorization processes were followed, unless the service was an emergency service.

Payment for service is contingent upon the service being provided to treat an emergency, or the service was in compliance with referral and prior authorization policies and procedures, as well as the billing guidelines.

For Buckeye members, all claims and encounters should be submitted to the general claim department address, unless it’s a specialty service as noted:

Buckeye Health Plan
P.O. BOX 6200
Farmington, MO 63640-3805

Dental claims should be submitted to:
Doral Dental Services of Ohio
12121 N. Corporate Parkway
Mequon, WI 53092

Routine vision claims should be submitted to:
OptiCare Managed Vision
ATTN: Claims
PO Box 7548
Rocky Mount, NC 27804

Behavioral health claims should be submitted to:
Cenpatico-Ohio Claims
PO Box 6150
Farmington, MO 63640-3806